Spinal Cord Infarction Due to Fibrocartilaginous Embolism: A Case Report and Review of Diagnostic Clues

Abstract

Spinal cord infarction is a rare entity, accounting for 1-2% of acute ischemic disorders of the central nervous system. Fibrocartilaginous embolism (FCE), characterized by migration of nucleus pulposus material into the spinal cord vasculature, constitutes an uncommon and underrecognized etiology. We describe the case of a 49-year-old woman, previously independent, who developed acute myelopathy with flaccid tetraparesis, C5 sensory level, and dysautonomia. Magnetic resonance imaging (MRI) revealed an extensive intramedullary lesion from C4 to T1 with diffusion restriction and disc extrusion at C6-C7 with annular fissure. After exclusion of other etiologies, the diagnosis of spinal cord infarction secondary to FCE was established. The patient started antiplatelet therapy, statin, and intensive rehabilitation, with neurological stability but without significant early functional recovery. This case illustrates the importance of considering this entity in adults with low vascular risk and disc degeneration, highlighting the crucial role of diffusion-weighted MRI in diagnosis, thereby ensuring appropriate management with impact on functional outcomes.